Provider Demographics
NPI:1689161127
Name:BRAHMBHATT, PAYAL (PA-C)
Entity Type:Individual
Prefix:
First Name:PAYAL
Middle Name:
Last Name:BRAHMBHATT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-1246
Mailing Address - Country:US
Mailing Address - Phone:470-355-7896
Mailing Address - Fax:
Practice Address - Street 1:3660 MARKET ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021-1246
Practice Address - Country:US
Practice Address - Phone:470-355-7896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2019-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant